EmblemHealth MNT coverage: codes, telehealth and limits
The short answerEmblemHealth pays 97802 and 97803 when the benefit covers it and the claim carries a diagnosis from its allowed ICD-10 table (diabetes, obesity, lipid disorders, Z71.3 and more). A physician must prescribe the service and the dietitian must be credentialed. Telehealth uses POS 02 or 10.
By Javier Alvarez · Updated · 1 min read
1 row: EmblemHealth. Public policy, not the member's benefits.
EmblemHealth
Commercial and Medicaid (Reimbursement Policy RP20250025) · New York
| 97802 | Listed (payable if a covered benefit, with a diagnosis from the allowed ICD-10 table) [1][2] |
|---|---|
| 97803 | Listed (payable if a covered benefit, with a diagnosis from the allowed ICD-10 table) [1][2] |
| G0270 | Limited (the medical guideline marks G0270 'cover for Medicare only'; the commercial and Medicaid policy does not list it) [2][1] |
| G0271 | Limited (the medical guideline marks G0271 'cover for Medicare only'; the commercial and Medicaid policy does not list it) [2][1] |
| Where it applies | Reimbursement policy RP20250025 covers Commercial and Medicaid and took effect 1/01/2026. The companion medical guideline was last reviewed Sept 8, 2023. The policy says benefits and frequency limits vary by plan and contract, so check the member's Evidence of Coverage. [1][2] |
| Diagnoses | Codes are eligible 'when reported with one of the diagnosis codes listed' in the policy's ICD-10 table. The table includes diabetes (E08 to E13), obesity (E66.x), lipid disorders (E78.x), eating disorders (F50.x), kidney disease (N18.x), pregnancy conditions, Z71.3 and Z68 BMI codes. [1] |
| Other codes | The reimbursement policy also lists 97804 (group), 98960 to 98962, 99078, and 0403T, G0108 and G0109 for Medicaid only. The older medical guideline lists S9470 and S9465 as applicable procedure codes; the reimbursement policy does not. [1][2] |
| Telehealth POS | Commercial and Medicaid plans consider telehealth for payment when it is audio and/or video and reported with POS 02 or 10 only (effective 06/01/2022). POS 10 pays the non-facility rate from 5/11/2023. [3] |
| Telehealth modifier | On a CMS-1500 professional claim, POS 02 or 10 identifies the service as telehealth and the telehealth modifiers are informational. Telehealth modifiers are required on UB-04 facility claims. [3] |
| Telehealth rules | 97802, 97803 and 97804 appear in the policy's telehealth services table with 'Yes' in the audio-only column. G0270 is marked 'Medicare Only' in that table. [3] |
| Visit limits | The guideline describes an initial assessment visit, follow-up visits, and reassessments as necessary during a 12-month episode of care. It says time-allowance parameters for MNT were removed Feb. 16, 2022. It names no visit cap. [2] |
| Referral and prior auth | Services must be prescribed by a physician and furnished by a provider credentialed by the plan. [2] |
| Who can bill | EmblemHealth considers payment when a qualified provider furnishes the counseling. The medical guideline requires a provider credentialed by the plan. [1][2] |
| Managed care plans | For EmblemHealth Medicaid plans, codes not on the Medicaid fee schedule are denied. [1] |
| Also | Not medically necessary per the guideline: conditions unrelated to dietary management (examples: attention deficit disorders, asthma, chronic fatigue syndrome) and general educational purposes. CPT 0488T (online structured behavior change program) is also not covered. [2] |
- EmblemHealth: Reimbursement Policy, Nutritional Counseling Services (Commercial and Medicaid) RP20250025, effective 1/01/2026, checked October 30, 2026
- EmblemHealth: Medical Guideline, Nutritional Counseling Services MG.MM.AD.09bC4 (last review Sept 8, 2023), checked October 30, 2026
- EmblemHealth: Reimbursement Policy, Telehealth and Virtual Care Services (Commercial, Medicare and Medicaid), 2026 edition, checked October 30, 2026
Check an EmblemHealth claim against the row
Before an EmblemHealth claim goes out, compare it with the row above: the code is one the policy lists, the place of service and modifier match for a video visit, and the units fit the limit. Change the filters to compare EmblemHealth with another payer, then download the PDF of what you see.